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LONDON:
JOHN CHURCHILL AND SONS, NEW BURLINGTON STREET.

MDCCCLXX.

PRINTED BY J. E. ADLARD, BARTHOLOMEW CLOSE, THE

BRITISH AND FOREIGN

MEDICO-CHIRURGICAL REVIEW.

JANUARY, 1870.

Analytical and Critical Reviews.

I.-Medical Politics. Associations formed for the purpose of exercising influence rather than of gaining legal powers are a new feature in our profession. Being a novelty, they are somewhat uncertain of their position, cautious in proclaiming their real character, and prone to disguise it by the assumption of scientific or benevolent intent. As we see no shame in the true bond of union, we shall, for the nonce, ignore these by-ends, and, without apology for lifting their veils, salute the British Medical Association and its twenty provincial branches, the Medico-Political Association, the Medical Teachers' Association, and several ethical societies scattered throughout the kingdom, as true political leagues. We welcome them with peculiar joy. Their use to the student of human affairs is very great, for they give him an opportunity of knowing the opinions of visible numbers of visible men, instead of trusting to their self-elected reflection in anonymous periodicals. It is needless to say that their primary object is to raise the rank of the profession in the commonwealth, and they come before the public as looking to the aid and protection of the State in various forms with this intent.

The introductory question which naturally must occur is

1 The Medical Profession and its Educational and Licensing Bodies. By E. D. Mapother, M.D., Professor of Anatomy and Physiology, Surgeon to St. Vincent's Hospital, &c. Dublin, 1868 (Carinichael Prize Essay).

General Medical Council; Report of the Committee on Professional Education, with Appendices. London, 1869.

Reports of Meeting of British Medical Association at Leeds, British Medical Journal, August and September, 1869.

Address of Samuel D. Gross, M.D., President of the American Medical Association. Philadelphia, 1868. 89-XLV.

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Why should the State interfere at all? What are the gravamina which its power is evoked to remove?

(1) In the first place medical men have to complain that the profession is rendered less influential as a body, and its individual members lessened in social consideration, by the legalised admission into their flock of incompetent practitioners, who do not receive, because they do not deserve, the confidence of their countrymen. Let any of our readers go to a chemist's shop in the artisans' quarter of any large town after work hours, and the crowds paying cash for advice and medicine, which they might at will get either gratis or on credit, or for a very small sum, from a registered practitioner, will make him hang his head and sadly confess that the millions do not receive the present legal guarantee as any evidence of the capacity of a medical man.

Dr. Heslop, of Birmingham, in a terribly suggestive pamphlet on “ The realities of medical attendance on the sick children of the poor in large towns,” gives the statistical details of an inquiry which he has conducted as to the means adopted by a consecutive series of 384 parents among the lower classes for relieving the ailments of their offspring. He found that nearly half had been without any advice at all, fifteen, or two fifths of the whole, had obtained it solely from a druggist or herbalist, and only forty-two had been to a medical man. At a colliery, in which the present writer was interested, a neighbouring practitioner of some standing, M.D., M.R.C.S., L.R.C.P., London, L.S.A., was salaried to attend the underground hands. He enjoyed a sinecure; for a deputation from the gangs waited on the foreman and represented that the owner's kindness was thrown away; since they preferred, when ill, to take their burnt skins or disordered stomachs to what they suggestively called “ the regular bonesetter.” The unregistered practitioner was evidently viewed in the West Riding as a more orthodox institution than his titled rival. Examples of this temper among the working masses will occur to every one, if he will temporarily remove from his eyes that bandage which esprit de corps has lovingly bound round them. In the case which is the subject of the last anecdote the contempt for the authorized adviser was quite unmerited ; but when we read in Dr. Heslop's pages “ignorance, recklessness, and hardness of heart," attributed to the established attendants on the labouring classes, we can easily understand the ill savour of the ointment, even though we should allow that no greater source of fetor than dead flies appear on the surface.

The distrust generated by individual instances is reflected upon our whole body. Ask an ordinary club cynic, who is declaiming against the doctors,” a reason for the faith, or rather want of faith, which is in him, and he is sure to answer by citing cases of wholesale or retail stupidity; and these are held to justify a disbelief, not only in physicians, but in physic altogether.

Now, the disgrace brought on us by unworthy members is, with a considerable amount of justice, ascribed to the imperfection of the tests which the State sanctions as enough to prove a man's competency to practise. Those who have the power of helping themselves reject those tests altogether. The army authorities submit candidates to a second examination, not on military but on general subjects. They consider that a medical adviser, who has been pronounced good enough to prescribe for the squire and the ploughman, is not proved thereby sufficiently expert to attend their brothers, the captain and the private. The Admiralty is equally careful of the lives of those who enter its service. Hospital authorities act in a similar way; they require private certificates of professional ability from the candidates of house-surgeoncies, and sometimes they submit them to a special examination. County magistrates and conscientious guardians think nothing of the diplomas of those seeking their patronage, but, to justify their choice, demand testimonials by the score, which they are sadly apt to count instead of weighing.

(2) Another complaint is that the just gains of qualified persons are intercepted by those who, without any medical training, pass themselves off on the public as competent advisers. As they have spent no time or money on their education they require smaller profits, and, as they have not the knowledge needful for inquiring into the cases of the sick, they can dispense over the counter remedies much quicker and cheaper than any one who tries to cure the patient. The death-rate of the United Kingdom is wonderfully inflated through this broad-casting of drugs by chemists and other shop-keepers out of sheer ignorance, and without any bad intent.

(3) A still more serious evil to the State, though one can scarcely affirm it affects the profession, is license given to persons calling themselves “Coffinites,” “ Herbalists,” or “Botanists;” who too often conceal the profitable trades of procurers and aborters beneath the thin veil of selling peculiar drugs. Under the same category come indecent advertisers and prurient museum-keepers. As Englishmen we may abhor their duplicity, but we cannot accuse them of injuring us as medical men. And we must also allow that Government gives them no direct encouragement, and tries to punish their offences after committal.

(4) We must, however, bring the very serious charge against Parliament of deriving a dirty addition to the revenue from

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